Project Community CARES (Cancer Awareness Program)
Contact:
Stephanie Wahab, wahabs@pdx.edu, 503-725-5083
While morbidity and mortality from colorectal cancer (CRC) can be easily reduced through the regular use of screening tests, screening rates remain significantly low. We have assembled a team of researchers and consultants from the University of Illinois-Chicago College of Nursing (U.M.) and Portland State University School of Social Work (S.W.) to compare the effectiveness of two interventions (Tailored Health Communication [THC] and Motivational Interviewing [MI]) in increasing CRC screening behavior.
Primary Aim
This five year study, titled “Increasing CRC Screening in Primary Care Settings,” is funded by the National Institute for Nursing Research (RO1 R01 NR08425). The study is conducted under the aegis of Project Community CARES (Cancer Awareness, Resources, Education, and Support) which is the overall cancer control program being developed by Dr. Menon. The primary aim of this study is to compare CRC screening test uptake among three groups randomly allocated to control or intervention conditions. The three study groups are (1) standard care, (2) tailored health communication, and (3) motivational interviewing. The two methods (THC and MI) will be compared to usual care and to each other.
Sample
Approximately 804 participants will be recruited from primary care clinics in Chicago, IL. To be eligible for participation on the study, participants need to be 50 years of age or older, CRC free, and be considered average risk for CRC.
The Interventions
THC and MI interventionists will contact study participants within one month of the baseline interview. THC counselors will be guided by printed tailored messages for each participant (drawn from the baseline interview). MI counselors will only receive information on the participants risk for CRC (collected at baseline). Both THC and MI interventionists will deliver a one-time intervention by telephone.
Study participants will be surveyed by telephone about CRC-related beliefs preintervention (Time 1), as well as at 1 month postintervention (Time 2), and at 6 months and 12 months postintervention (Times 3 and 4, respectively).
Tailored Health Messaging
According to Kreuter, Farrel, Olevitch, & Brennan (2000), tailored interventions are defined as any combination of personalized information or change strategies intended to reach a given individual. The personalized information or change messages are derived from an individual assessment, and they are grounded in characteristics that are unique to that individual, as well as relate to the outcome of interest. Tailoring has been compared to non-tailored communications; for instance, tailored letters have been compared to generic letters. While certain studies demonstrate that tailoring, by itself, has succeeded in promoting behavior change, tailored cancer communication has not been compared to other forms of cancer communication In this study of Project Community CARES, the intervention will be tailored to baseline stage of readiness for CRC screening and CRC-related beliefs associated with each stage. Perceived benefits and perceived susceptibility will be emphasized for those in precontemplation, and perceived barriers and benefits for those in contemplation. Additionally, self-efficacy specific to the screening test will be addressed for those with low self-efficacy in any stage.
The one-time, telephone-based MI intervention will include the following components: establish rapport, ask permission to discuss colorectal cancer prevention (CCP), invite participants to discuss what they know about CCP, assess motivation, readiness and confidence to get screened, explore ambivalence, roll with resistance, elicit and enhance change talk, support self-efficacy and commitment.
Analysis
Data analysis will include bivariate analysis among beliefs, demographics, and screening test uptake. Logistic regression models will be used to identify significant belief and demographic predictors of stage of CRC screening test adoption as well as screening test uptake by study group. Process evaluations of the interventions will be conducted periodically, including exploratory analysis of audiotaped interventions. Path (mediation) analysis will be performed to further explore the underlying mechanisms through which THC and MI may differentially impact screening behavior.
In summary, the innovative comparison of two interventions that have not been compared to date within the same study, as well as the fact that we are adapting successful interventions to CRC screening are both strengths of the study. Together with a strong conceptual framework and the expertise of the research team, we believe that the proposed study can make a significant contribution to cancer control research.